Fecal diversion in anorectal malformations: is there a place for ileostomy? The ARM-Net Consortium experience including a narrative literature review

PURPOSE: While colostomy is the standard stoma in patients with anorectal malformations (ARM), indications for ileostomy remain poorly defined. Our aim was to evaluate indications and outcomes of ileostomy in patients with ARM. METHODS: A retrospective study was conducted selecting patients from ARM-Net Consortium registry who received ileostomy between 2007 and 2024. Additionally, a literature review was conducted to contextualize findings. RESULTS: Among 2,994 patients, 21 (0.7%) underwent ileostomy. Data was available for 15 patients. Ileostomy was used mainly in complex malformations (N = 9), including cloacal exstrophy (6), pouch colon (2), and variant of OEIS complex without exstrophy (1). Ileostomy was performed before anorectal repair in 73%, during in 13.5%, and after in 13.5%. Other indications were concomitant bowel pathology, post-operative complications, and protective stoma during reconstruction. Ileostomy-related complications occurred in 40% of patients, 27% being grade IIIB according to Clavien-Madadi. Closure was performed in 87%, while some patients received permanent stoma. In the literature ileostomy was mentioned only in case reports or small case series. CONCLUSION: Ileostomy is a selective surgical option in the management of ARM, with a high complication rate. It should be reserved for complex malformations or complicated cases where a colostomy is unsuitable, insufficient or unfeasible.